Healthcare Provider Details

I. General information

NPI: 1275917759
Provider Name (Legal Business Name): ANN MARIE CRUSE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 DAKOTA AVE S
HURON SD
57350-4026
US

IV. Provider business mailing address

1950 DAKOTA AVE S
HURON SD
57350-4026
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-6496
  • Fax: 605-352-7519
Mailing address:
  • Phone: 605-352-6496
  • Fax: 605-352-7519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4560
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17326
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: